San Rafael, CA – Imagine being told you have contracted COVID-19.
Now imagine being the person who has to tell that person he or she has contracted the potentially deadly coronavirus strain.
As soon as a Marin County resident tests positive for the virus, public health professionals are mobilized to prevent the potential spread from the infected individual to others. The tracing of those contacts has become a specialized art form in the past few months, and Jill Aggersbury of Novato is one of the sleuths. Aggersbury, a retired nurse, is volunteering with Marin County Public Health as part of the Marin Medical Reserve Corps (MMRC).
Jill Aggersbury of Novato, a retired nurse, works on COVID-19 contact tracing from her home. She is one of about 70 people assisting with pandemic response through contact tracing.It’s not easy to break the news to a new COVID-19 patient, but gradually by asking questions and the patient hearing answers, the afflicted tend to calm down and understand the steps toward getting healthy.
“You don’t necessarily need a medical background to do this work, but what you need is empathy and patience,” Aggersbury said. “I have 50-plus years of experience and knowledge and would like to put that to good use, and I know others feel the same way I do. Somebody recently said to me that nothing can prepare you for this job. It can be very emotional and hard work.”
Most MMRC members are retirees from the health care industry or those heading into the final years of their working careers. They are called out in times of disaster and regularly train for responses to earthquakes, wildfires, floods, and other mayhem. The difference with the coronavirus pandemic is that most the MMRC service is virtual instead of hands-on. Over the past three months, Aggersbury has worked the phones to speak with new COVID-19 patients and helping them retrace their steps so others who had been in close quarters with that patient can be contacted and tested right away.
Here's how the notification process works: The list of test results comes into Marin County Public Health, and the positive results are routed to the contact tracing unit. A member of a “rapid response” team is often the first to reach out to the new COVID-19 patient, followed by a case investigator who offers health and resource advice. That interviewer asks questions about the patient’s whereabouts over the past few weeks and offers advice about quarantining and health. After that, the contact tracers research the geographic patterns of the patient and start reaching out to people who might have been in contact with the infected individual. The final step is for a resource specialist to make sure the patient has access to daily assistance and supplies.
Aggersbury has played all those roles.
“These practices have changed over time as we fine-tune the process,” she said. “I started on this about three months ago, and now we have more core personnel coming in to assist. People now are more aware of contact tracers. Often, they are surprised about their test results, but they’re not as surprised about why we are calling them.”
In May, the State of California launched CalCONNECT, a comprehensive case investigation and contact tracing program and public awareness campaign to address the pandemic. It was instituted in Marin in July, and since then the local team has investigated more than 2,000 cases. During the week of August 17-23, there were 332 new local cases and contacts entered into CalCONNECT, and the team completed investigations for 502 cases and contacts. Although there is wide variability, each new case is associated with two or three exposed contacts, consistent with statewide figures.
Aggersbury works online along with about 70 others who share responsibility for personally reaching out to every case. Together they represent the diversity of Marin’s neighborhoods. Spanish language is an especially important skill, and tracers have been recruited from Latinx communities. Aggersbury said it’s been particularly interesting to communicate with multigenerational families and interpreters. Unfortunately, she has dealt with several COVID-19 patients living together with a wide range of ages – and sometimes even surnames – among the family members.
“I’m really impressed with how some of the families manage isolation and quarantine,” she said. “They’re very diligent. It’s hard for the kids if they have them … sometimes seven of them in one apartment. I’m impressed with how they’re dealing with it, especially when their finances are stretched, and they can’t go back to work. Many have friends and family who will deliver food to them.”
The MMRC specialists make sure patients have access to guidance from the U.S. Centers for Disease Control, the California Department of Public Health, and major health care providers in addition to recommendations from Marin County Public Health staff. The key recommendations have been the same since the start of the public health crisis: wash hands, a wear face covering, sanitize/disinfect often, and keep away from others as much as possible.
“Don’t go to any parties, please,” Aggersbury said. “Save those for later on.”
A native Londoner, Aggersbury came to the United States in the 1970s and settled in Marin about 20 years ago. She worked for the British Red Cross and the American Red Cross, and she has worked in other countries including five years in Saudi Arabia. MMRC members have been dispatched to many California wildfires in recent years, too. She loves to travel but has put off her own vacation plans for the time being. When she’s not volunteering with COVID-19 contact investigations, she’s getting the backyard in order and cleaning out her garage and home just like everyone else. She doesn’t see an end to the pandemic this calendar year.
So, in the meantime, Aggersbury is pleased to contribute her time and possibly help save lives with other members of MMRC, Marin County Public Health, and all the other front-line health workers.
“The whole team I’ve worked with, I’m very impressed with them – everybody from the county, the state, and all the volunteers,” she said. “We have great teamwork going on. At the end of each day, we discuss the problems we had, share anecdotes, and work things out. Everybody is willing to make suggestions to improve the process. The rapport has been established over Zoom (videoconferencing), and the camaraderie is tremendous. This is rewarding for me.”